Cognitive Remediation in Forensic Mental Health Care

  • participants needed
  • sponsor
    The Royal Ottawa Mental Health Centre
Updated on 28 January 2022
cognitive deficits
cognitive remediation


Forensic patients often display cognitive deficits, particularly in the domain of executive functions, that represent a challenge to forensic rehabilitation.

One empirically-validated method to train executive functions is cognitive remediation, which consists of cognitive exercises combined with coaching.

This trial investigates whether cognitive remediation can improve cognitive, functional, and clinical outcomes in forensic inpatients.


Forensic patients often display deficits in executive functions, namely difficulties in planning, strategic thinking, problem-solving, and inhibiting inappropriate behavior. Such deficits are transdiagnostic and often underlie behavioral incidents, undermine reintegration into the community, and increase recidivism risk. Despite this, forensic programs usually do not include executive function training.

One approach to train executive functions is cognitive remediation, which consists of behavioral exercises engaging cognitive skills, supported by coaching. In various mental health conditions, cognitive remediation has been repeatedly associated with improvements in cognitive, functional, and clinical outcomes, with small-to-moderate effect sizes. Thus, it should be clarified whether this approach can lead to similar improvements in forensic populations.

In the present trial, we will investigate whether 12 hours over 6 weeks of computerised cognitive remediation administered using tele-health can improve executive functions relative to an active control condition in a sample of 30 forensic inpatients (Aim 1). We will further examine the effect of cognitive remediation (vs. active control) on other variables that are critical for forensic rehabilitation, namely oppositional behaviour, functional capacity, and mental health symptoms (Aim 2). Lastly, we will explore whether any effects persist 12 weeks following cognitive remediation (Aim 3).

Cognitive remediation is an evidence-based inexpensive training method that could be integrated into forensic healthcare practice. In the long term, the expected cognitive, functional, and clinical improvements associated with cognitive remediation have the potential to result in shorter hospitalisations and reduced recidivism rates.

Condition Attention Deficit/Hyperactivity Disorder (ADHD - Pediatric), Psychosis, depressed mood, Drug use, Drug abuse, Depression (Major/Severe), Schizophrenia, Depression (Adult and Geriatric), Offenders, Attention Deficit/Hyperactivity Disorder (ADHD - Adults), Depression (Adolescent), Anxiety Disorders, anxiety disorder, Total Body Irradiation, Violence, psychotic disorder, Anxiety, Substance Abuse, Depression (Treatment-Resistant), Depressed, schizophrenia disorders, adhd, depressive disorder, traumatic brain injury (tbi), neurocognitive disturbance, psychotic disorders, Depression, Attention deficit hyperactivity disorder, psychotic, Aggression, Endogenous depression, depressive disorders, Cognitive Dysfunction, Cognitive Impairment, Family Medicine-ADHD Pediatrics, Schizophrenia and Schizoaffective Disorders (Pediatric), Anxiety Symptoms, miserable, Anxiety Disorders (Pediatric), Generalized Anxiety Disorder (GAD - Pediatric), Brain Injury, substance use disorder, Generalized Anxiety Disorder (GAD), Depression (Pediatric), substance use disorders, Antisocial Behavior, Schizophrenia and Schizoaffective Disorders, ANXIETY NEUROSIS, anxious, Cognitive Impairments, total-body irradiation, Traumatic Brain Injury
Treatment Cognitive remediation, Active control
Clinical Study IdentifierNCT04610697
SponsorThe Royal Ottawa Mental Health Centre
Last Modified on28 January 2022

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